One of the most significant factors that can shift, or bend, the trajectory of discovery is lobbying by patients. Patient advocacy organizations (PAOs), in their most modern form, emerged in the 1940s and 1950s as patients shared their experience of living with a disease - later morphing into self-help organizations. Over time, these groups have grown in stature and currently play a significant role in steering the direction of research. Additionally, the private sector is another important actor that can lobby for research agendas to be changed, either indirectly through patient organizations or by directly influencing policymakers. The way they achieve this, and the degree to which they succeed in redirecting the research trajectory, is the main focus of Chapter 13.